Current Practices and Perspectives on Breast Cancer Screening and Treatment in Older Women with Dementia

OBJECTIVES To explore the nature of breast cancer screening and treatment decisions in older women with dementia. DESIGN Thematic analysis of semistructured telephone interviews. SETTING Alzheimer's Disease Research Center Registry. PARTICIPANTS Twenty-three family caregivers (CGs) of women with dementia (WWD). MEASUREMENTS Semistructured questions regarding CGs' perceptions of current and predementia beliefs held by the WWD about the importance of regular screening mammograms, CGs' views about the importance of obtaining regular screening mammograms for the WWD and whether dementia stage of the WWD influenced these views, and CGs' view of what level of treatment would be appropriate if WWD they were caring for were to be diagnosed with breast cancer. RESULTS In CGs of women with mild to moderate (but not severe) dementia, mammogram importance ratings reflected perceived predementia importance levels (generally high). Most CGs of women with mild to moderate dementia planned to continue screening regardless of dementia severity of the WWD, but CGs of women with severe dementia at the time of the interview did not generally consider screening important. Physician recommendations were frequently found to influence screening practices. CGs' views on appropriate treatment if the WWD developed breast cancer varied widely except in the case of severe dementia, in which case comfort care was consistently preferred. CONCLUSION Breast cancer screening and treatment in dementia are active areas for healthcare decision-making, and supportive interventions involving physicians, CGs, and WWD are needed.